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The Problem
“My child has a bump on (or near) his eye.”
Common Causes
Newborns
Hemangioma
Dermoid
Mucocele
Older children
Stye/chalazion
Other Causes
Newborns
Conjunctival dermolipoma
Encephalocele
Older children
Molluscum contagiosum
Keratin cysts
Pilomatrixoma
Conjunctival nevus
KEY FINDINGS
History
Infantile capillary hemangioma
Initially noted in first few weeks of life
Grows rapidly in first 1 to 2 months
Orbital dermoid
Present at birth (though may not be noticed until later)
Most commonly located at superolateral orbit
Mucocele
Present at or shortly after birth
Mass on medial canthus
May have symptoms of lacrimal obstruction
If large, associated nasal cyst may cause respiratory difficulties
Stye/chalazion
Initial eyelid erythema (may mimic cellulitis)
Usually evolves into discrete nodule
Examination
Infantile capillary hemangioma
Vascular-appearing lesion
If subcutaneous, vascular character may not be visible
May have hemangiomas elsewhere on the body
Dermoid
Smooth, firm, subcutaneous nodule
Most commonly located at superotemporal orbital rim
Mucocele
Usually blue-tinged mass overlying lacrimal sac
If infected, becomes erythematous
May have periocular crusts, discharge
Stye/chalazion/hordeolum
Initially may have diffuse eyelid swelling and erythema (may mimic cellulitis)
Usually develop erythematous nodule, often with white center
May drain spontaneously
If chronic, usually firm nodule
May have multiple, recurrent lesions
Blepharitis common (crusts of lashes, erythematous lid margin)
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Infants with noninfected mucoceles should be treated with warm compresses and topical antibiotics. If the lesion does not resolve, or if the mucocele becomes infected, referral to a pediatric ophthalmologist is indicated.

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Infants with hemangiomas involving the eyelids or periocular structures should be referred to a pediatric ophthalmologist due to the risk of amblyopia.

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Styes and chalazia should be treated initially with warm compresses. Topical antibiotics may also be used. Most resolve with conservative treatment in 1 to 2 months. If they do not, referral for incision and drainage may be indicated.

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What Shouldn’t Be Missed

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Infantile mucoceles are almost always associated with nasolacrimal duct cysts. If these are large, they may cause respiratory difficulties. These patients require prompt nasal endoscopy and removal of the cysts.

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  • 1. Hemangioma. Hemangiomas are vascular lesions that develop within the first few weeks of life. They usually go through a fairly rapid growth phase over the next few months, then slowly involute. The lesions themselves are benign, but periocular hemangiomas can cause amblyopia, either due to obstruction of vision or by inducing astigmatism (Figure 13–1).
  • 2. Orbital dermoids. Orbital dermoids are benign lesions that arise from entrapment of ectodermal tissue between the growth plates during the embryological development of the skull. They are most commonly located along the superolateral orbital rim (Figure 13–2). They may rupture, which can incite a marked inflammatory response.
  • 3. Mucocele (dacryocele, dacryocystocele, amniotocele). These lesions result from dilation of the lacrimal sac in newborns with lacrimal obstruction. They present as blue-tinged masses overlying the lacrimal sac between the eye and ...

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